Golden Arches

A multidisciplinary team at the OSUCCC – James has pioneered a surgical technique that used false pedicles to reconstruct a load-bearing pelvic/spine structure to support and protect the spine following a complex cancer surgery.

Ehud Mendel, MD, FACS, and his colleagues built the false pedicles after en bloc resection to treat iliosacral chondrosarcoma with lumbar spine.

“Primary bone tumors such as chondrosarcomas must be removed completely intact; otherwise, the cancer is guaranteed to recur,” says Mendel, the Justin Skestos Chair in Minimally Invasive Neurological Spinal Surgery and professor of Neurosurgery, Oncology and Orthopaedics at the Ohio State. “This technique allows fixation of the spine after the tumor is removed.”

Removing these tumors intact (en bloc resection) is especially challenging, notes Mendel, who also directs Ohio State’s Spine Oncology Program. “They often involve supporting bones in the pelvis and lower spine that are critical for maintaining mobility and bowel and urinary continence.”

“Pedicle” refers to the short extensions of bone that help form the arches on each vertebra. The arches protect the spinal cord as it runs down the spinal column. Treating primary bone tumors often requires rebuilding structures needed to support the spine and pelvis. This surgical technique creates an artificial spinal support structure that incorporates narrow segments of living bone attached to the spinal column.

False pedicles were created using bone grafts from an amputated lower limb. These were attached to the patient’s vertebrae, where they develop blood vessels that promote their growth and fusion. Surgery for primary bone tumors such as chondrosarcoma must be customized based on tumor characteristics and anatomical involvement.

Prior to surgery, Mendel’s team builds a 3D model of the patient’s spine to map the customized support system. “Creating false pedicles allows us to reconstruct a patient’s spine and a functional load-bearing pelvic structure,” Mendel says. “This gives patients the potential to walk with early mobilization.”

Published in the Journal of Neurosurgery: Spine.

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